GIFT Bursary - Rebecca Johnston - Lautoka FIGI

Report by GIFT Bursay Rebecca Johnston

Getting Ready for the Birthday Party

Lautoka. Fiii

I arrived in Lautoka, Fiji on the 29th June 2015 to begin my 6 and a half week placement at the city's only hospital. This was an essential part of my 4th year in medical school. I was placed in the
Obstetrics and Gynaecology department as this is something I am interested in. During my stay I was living with an indigenous Fijian family for the duration, which helped me to experience the true Fijian culture and gain an insight into way of life.


Fiji lies in the Pacific Ocean, 2000 miles northeast of Australia. lt comprises of 332 islands, the largest of which is Viti Levu. Lautoka is the second largest city situated on the west side of Viti Levu, with a population one third of the size of the city Suva, the capital. Fiji is inhabited by two main populations native Fijians and lndians. These populations live in close communities, often in the same location as all their friends and family members.

52% of the population are Christians, the majority of which are Methodists. The other main religions represented are Hinduism (38%) and lslam (8%).

The health care system in Fiji was inherited from the British Colonial administration so is essentially a three-tire system-with primary, secondary and tertiary levels similar to the UK. The system is decentralised and managed locally by subdivisions of the health services, all with the ability to perform inpatient and outpatient services. The health care subdivisions also take responsibility to provide health professionals to support the small rural villages and segregated communities.

My hospital placement

My timetable for placement in obstetrics and gynaecology department of Lautoka hospital was as follows: mornings were based in antenatal clinic where I had my own set of low risk patients for routine consultations and afternoons were split between labour ward, antenatal ward, gynaecological wards and theatre for caesarean sections.

ln antenatal clinic I was expected to take a brief history of the pregnancy since the last check up, review their observations, perform an obstetric examination, decide whether any further  investigations were needed and book them in for their next appointment. This was quite a step up
from the responsibilities I would be given in an antenatal clinic in England however I did not feel out of my depth. I was unsure to start with so asked to observe a doctor during one of her consultations and then felt confident to begin my clinic.

On labour ward I joined the team performing checks on the labouring ladies to monitor their progression, this involved examining the patients to calculate their Bishop score and counting their contractions. The patients also welcomed support and encouragement as they are not allowed birthing partners and there can be up to 10 ladies in the labour room at one time, all at different stages of labour, thus making it quite a scary place. The midwives encouraged me to assist in deliveries and allowed me to take the lead in low risk births.
On my antenatal and gynaecological ward placements, I was mainly asked to clerk new patients and present their cases to the attending doctor and then help carry out basic investigations as necessary. These included blood pressure and other outline observations, taking baseline bloods and sending them to the laboratory and inserting cannulas if needed. All of these responsibilities were similar to those I have undertaken in England on placement.

During the caesarean sections I observed initially and then was asked to scrub in to assist. This was something I had done on placement in England, with only the scrubbing in system being different.

Mv Fijian familv experience

I was lucky enough to be able to stay with a F'tjian family, which consisted of husband and wife, Bola and Kathleen, their son Enrique and long term Japanese student, Keito. The rent included a room to stay and breakfast and was sufficient to pay for the rent and running of the whole house for 3 months. I quickly formed a good relationship with the family, as a result I had my evening meal with them most nights, they were willing to accept a donation towards food and were grateful for the evenings where I  cooked for them. They put this money to good use; paying off some of their debt and buying appliances for the home that they did not previously have such as a toaster, washing machine and oven. I was also able to help them by looking after Enrique, cooking for him on the nights his parents were out and taking him out on day trips around this island- he had previously not experienced such days out. Keito also benefited from me living with him as he was able to practice speaking English.

During the first week ! was invited to Kathleen's nephew's first birthday party. Unlike England, this is a significant occasion as the infant mortality rate is high so reaching their first birthday is worth celebrating. The pafi was a big event in the community with all local children invited along with many family and friends. The celebrations revolves around food, however the food cannot be served until the child's father has given a speech. This was very moving as he spoke about how blessed him and his family were to have Mathius as one of their family. After this the food was served, it was cooked in the in the underground oven called the Lovo. The married men were unable to eat any food until all of their wives had eaten and given their permission for the men to eat.

The traditional offering to a hosting family in Fiji is Kava. This is a dried root from the pepper plant; this then gets pounded to a fine powder and mixed with water to make the traditional kava drink. This is drunk from bowls made from coconut shells, and is ceremonially drunk during any celebration and on a regular basis as a form of relaxation. Midway through my stay, I bought my homestay family 1Kg of Kava, the family invited their friends and extended family over to enjoy drinking it with us.

Before I returned to England, my homestay family organised a celebratory leaving meal. This was cooked in the traditional Lovo.  Lovo is a shallow hole in the ground in which volcanic stones are heated until very hot and these are put around the meats, bread and root veg. The food and rocks are then covered with banana tree leaves and earth and it is left for upto 2 hours for the food to cook. The food has an amazing smoky flavour and is very tender. lt was a real privilege to be able to share this meal with them.

This was an incredible experience and I was very lucky to be able to go. I have gained valuable knowledge from working in the hospital and the Fijian people have enriched my life in many ways.  Their customs, attitudes to life and hospitability will stay with me for a long time.